43-year-old woman with positive anti-nuclear antibody - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-10-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 26
Threads: 10
Thanked 88 Times in 24 Posts
Reputation: 98
Question 43-year-old woman with positive anti-nuclear antibody

A 43-year-old woman has noted for the past 2 years that her fingers turn white and become painful upon exposure to cold. Shown below is the appearance of the antinuclear antibody test using her serum at a titer of 1:1024.

43-year-old woman with positive anti-nuclear antibody-nuclearpattern.jpg
click image to enlarge


Which of the following complications is this patient most likely to have at this time?

A Dysphagia
B Anemia
C Melena
D Lymphadenopathy
E Skin rash
Reply With Quote Quick reply to this message
The above post was thanked by:
cerebrum85 (03-11-2011), chulady (03-10-2011), gzmdkmn (09-27-2011)



  #2  
Old 03-10-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 27
Threads: 4
Thanked 22 Times in 10 Posts
Reputation: 32
Default

CREST,scleroderma... 'A'
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (03-10-2011)
  #3  
Old 03-10-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,463 Times in 357 Posts
Reputation: 1473
Arrow My ans is A) Dysphagia

My ans is A) Dysphagia

CREST syndrome - Systemic Sclerosis (scleroderma)

Calcinosis (calcium deposits)

Raynaud's, usually in the fingers (fingers turn white and become painful upon exposure to cold)

loss of muscle control of the Esophagus, which can cause difficulty swallowing

Sclerodactyly, a tapering deformity of the bones of the fingers

Telangiectasia, small red spots on the skin of the fingers, face, or inside of the mouth.

Antibodies: Anticentromere Antibodies
Reply With Quote Quick reply to this message
The above post was thanked by:
Dra.RecioO (03-10-2011)
 
  #4  
Old 03-10-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,463 Times in 357 Posts
Reputation: 1473
Arrow Similar one....from NBME

A 45-year-old woman comes to the physician because of a 6-month history of mouth ulcers, thickening of the skin, and throbbing pain in her hands when they are exposed to cold. She also has a 1-month history of severe headaches and difficulty swallowing. Physical exam shows small red lesions around the mouth and generalized muscle weakness. Labs show a high titer of anti-Scl 70 antibody. A biopsy specimen of the skin shows thinning epidermis, hyalinization and obliteration of arterioles, and dermal thickening. These dermatologic changes are caused by a release of chemokines from which of the following inflammatory cell types?

A) Endothelial cells
B) Eosinophils
C) Lymphocytes
D) Mast cells
E) Platelets
F) Segmented neutrophils
Reply With Quote Quick reply to this message
The above post was thanked by:
cerebrum85 (03-11-2011), chulady (03-10-2011), Dra.RecioO (03-10-2011), raheel_memon (03-10-2011)
  #5  
Old 03-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 91
Threads: 3
Thanked 120 Times in 47 Posts
Reputation: 130
Default

Please note that Raynaud phenomenon can be present in several ANA diseases. Although it is true that 90% of Scleroderma/CREST present with RP, it's also present in 85% of mixed connective tissue disease, as well as systemic lupus erythematosus where it can be a common presenting complain.
Reply With Quote Quick reply to this message
The above post was thanked by:
Dra.RecioO (03-10-2011)
  #6  
Old 03-10-2011
USMLE Forums Scout
 
Steps History: ---
Posts: 95
Threads: 30
Thanked 33 Times in 27 Posts
Reputation: 43
Arrow A is the answer!

I think the Answer is A...but I am not 100 % sure...please do explain the answer...thanks!

Quote:
Originally Posted by aktorque View Post
A 45-year-old woman comes to the physician because of a 6-month history of mouth ulcers, thickening of the skin, and throbbing pain in her hands when they are exposed to cold. She also has a 1-month history of severe headaches and difficulty swallowing. Physical exam shows small red lesions around the mouth and generalized muscle weakness. Labs show a high titer of anti-Scl 70 antibody. A biopsy specimen of the skin shows thinning epidermis, hyalinization and obliteration of arterioles, and dermal thickening. These dermatologic changes are caused by a release of chemokines from which of the following inflammatory cell types?

A) Endothelial cells
B) Eosinophils
C) Lymphocytes
D) Mast cells
E) Platelets
F) Segmented neutrophils
Reply With Quote Quick reply to this message
  #7  
Old 03-10-2011
Dra.RecioO's Avatar
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 5
Threads: 0
Thanked 2 Times in 2 Posts
Reputation: 12
Default

I think the answer is skin rash
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #8  
Old 03-11-2011
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 4
Threads: 1
Thanked 0 Times in 0 Posts
Reputation: 10
Wink

............think its antiNUCLEOLAR antibody..............therefore must b systemic sclerosis......... A) wud b my ans......
Reply With Quote Quick reply to this message
  #9  
Old 03-11-2011
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 144
Threads: 34
Thanked 82 Times in 37 Posts
Reputation: 92
Question

Quote:
Originally Posted by aktorque View Post
A 45-year-old woman comes to the physician because of a 6-month history of mouth ulcers, thickening of the skin, and throbbing pain in her hands when they are exposed to cold. She also has a 1-month history of severe headaches and difficulty swallowing. Physical exam shows small red lesions around the mouth and generalized muscle weakness. Labs show a high titer of anti-Scl 70 antibody. A biopsy specimen of the skin shows thinning epidermis, hyalinization and obliteration of arterioles, and dermal thickening. These dermatologic changes are caused by a release of chemokines from which of the following inflammatory cell types?

A) Endothelial cells
B) Eosinophils
C) Lymphocytes
D) Mast cells
E) Platelets
F) Segmented neutrophils

i am so buzzled
but it may be C vs A.......
look these.......
CREST Syndrome: eMedicine Dermatology


B7 Immunology Page

i think that was the most appropriate.... making answer mostly C ....???
[PDF] Antibodies to membranes of endothelial cells and fibroblasts in ..
__________________
“Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning. ”
Albert Einstein
Reply With Quote Quick reply to this message
  #10  
Old 03-11-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,463 Times in 357 Posts
Reputation: 1473
Arrow NBME Ans

Who ever haven't done NBME yet, please don't bother reading this...

Ans for the qn above regarding CREST syndrome....

The NBME ans key for this qn is C) Lymphocytes. , Why!!! because CREST syndrome is an autoimmune disease. Majority of the autoimmune disease are caused by abnormal lymphocytes (T lymphocytes) and their toxic cytokine released products. These chemokines and cytokines then cause destruction on the endothelial cells.

This is what the national board of research asso. USA says that .... Autoimmune prone MRL/Ipr mice have been reported to have deffective Fas gene. (Fas gene for executing poor cells) which would presumably alter the negative selection in the thymus. In other word, decrease responsiveness to clonal deletion signals in the thymic cortex. This type of phenomena, will lead to all T-lymphocyte related autoimmune disease.

in addition, (regards scleroderma)

Inflammatory cells commonly aggregate at the dermal-adipose junction, particularly in early lesions. Cytokines produced by these inflammatory cells (transforming growth factor-β, tumor necrosis factor-α (TNF-α), interferon gamma (IFN-γ), and interleukin-6 (IL-6) are all present at high levels in the serum of patients with scleroderma, and are thought to play a central role in the pathogenesis of the disease.
Reply With Quote Quick reply to this message
The above post was thanked by:
cerebrum85 (03-11-2011), dr_lizard (10-13-2011), Dra.RecioO (03-11-2011)
  #11  
Old 09-27-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 345 Times in 138 Posts
Reputation: 377
Default

hey thnx for explaining!
Reply With Quote Quick reply to this message



Reply

Tags
Figures-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
40-year-old woman with thrombocytopenia Taiyakikung USMLE Step 1 Forum 4 02-26-2011 03:44 PM
54-year-old woman with a pansystolic murmu sam01 USMLE Step 1 Forum 8 05-14-2010 07:04 AM
A 30-year-old woman presents to a physician mudpiles USMLE Step 1 Forum 7 04-12-2010 04:22 AM
An HIV positive woman on HAART Hohepa USMLE Step 2 CK Forum 4 03-09-2010 10:04 PM
Nuclear Plant Accident! Sharer USMLE Step 1 Forum 3 02-25-2010 10:03 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)